Rational Use Of Antibiotics Among Patients Admitted To Critical Care Units At Kenyatta National Hospital And Its Impact On Clinical Outcomes

Abstract

Background: Studies have postulated that approximately a third of the antibiotic use worldwide is irrational, posing a major global challenge to containment of drug-resistant infections. In the critical care units, irrational antibiotic use is associated with high mortality rates. In Kenya, there is scarce data on rational use of antibiotics within critical care units and its impact on patient clinical outcomes. Study Objective and Setting: This study sought to evaluate rational use of antibiotics among patients admitted to various Critical Care Units at Kenyatta National Hospital (KNH) and its impact on clinical outcomes. Methods: A retrospective cross-sectional study was conducted by reviewing 220 eligible patient medical records from various Critical Care Units at the Kenyatta National Hospital. Patients were recruited by stratified proportionate sampling depending on the admission capacity of each unit. The data extracted into predesigned tool included patient demographics, antibiotic choice, dosage and clinical outcome which was either discharge or death. Raw data was coded, entered into Microsoft Excel Version 2013 to create a database and then exported to STATA Version 13 for analysis. Pearson’s Chi square and Fischer’s exact test were used to determine associations between predictor variables such as patient demographics and outcome variables like rational prescribing. Logistic regression was used to measure the independent correlates of rational antibiotic prescribing and mortality. Statistical significance was set at 95% confidence interval and values with p≤0.05 were considered statistically significant. Results: The mean age of participants was 31.2±15.7 years with a male preponderance (n=129, 58.6 %). Cephalosporins (49.6%), 5-nitroimidazoles (18.2%) and penicillins (14.2%) were the most frequently prescribed classes of antibiotics. The prevalence of irrational use of antibiotics was high at 81.5%, with antibiotic choice, dose, duration and frequency being incorrect for 51%, 14.4%, 32.3% and 29.2 of the instances, respectively. Rational use of ceftriaxone was statistically significantly associated with the type of disease being treated (p=0.012). Mortality at critical care units was 11.1%, with the odds of death being at least five times among intubated patients compared to those who were not (AOR 5.5, 95% CI=1.1-28.1, p=0.042). xiv Conclusion: The prevalence of rational antibiotic use was 18.5%. The high proportion of irrational use was contributed by incorrect choice and incorrect duration of antibiotic use. The outcome of antibiotic therapy in critical care units was correlated with extent of the disease. Recommendations: The hospital antimicrobial stewardship committee needs to focus on potential targets for improvement such as the choice and duration of treatment with antibiotics. Further research is required on determinants of antibiotic prescribing among clinicians in order to give a better understanding on the factors that guide antibiotic prescribing.